The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Audit Improvement and Reform (AIR) Act of 2014 (H.R. 5083), which was introduced on July 11, 2014, by Reps. Renee Ellmers (R-NC) and John Barrow (D-GA), and backed by a bipartisan group of four co-sponsors, aims to relieve pressure DME suppliers face from Recovery Audit Contractor, Medicare Administrative Contractor and other program integrity audits.

The bill addresses the following points: it requires the reporting of error rates on audited claims after adjustment for those audited claims that have been overturned on appeal; requires thorough education and outreach; removes for one year all suppliers who have an error rate on audited claims of 15 percent or less (restricting them to one random claim audit per year); and reinstates clinical inference which allows auditors to look through the medical record to substantiate claims of medical necessity.  The bill also limits look-back periods while fixing timely filing constraints on appeals. 

The legislation was introduced shortly after the July 9 Senate Aging Committee Roundtable, “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations” and the House Oversight and Government Reform Committee’s July 10, 2014 hearing, “Medicare Mismanagement Part II: Exploring Medicare Appeals Reform.”  The NASL Products Committee will discuss the legislation.